Health technology must provide other ways of working
Technology can help save the healthcare sector, but it must be used to organize work in new ways.
Technology will help to maintain and strengthen health and care in a situation where more and more people need the services - at the same time as the number of healthcare workers cannot be increased as quickly.
A number of studies and reports, such as the Health Personnel Commission's report from 2023, show that the services could collapse if we do nothing. They also point out that technology can play an important role in reducing the number of staff per patient.
To make use of technology in the transition, the ability to change and reorganize is at least as crucial as the choice between technological solutions.
In the PROTECT network project, Nordic researchers have come together to promote and unite Nordic research-based knowledge about health and welfare technology. You can read some of their specific advice in two fact boxes further down in the article.
Did not realize
In 2011, the white paper “Innovation in care” pointed to a huge, untapped potential for using technology in care services.
- The narrative was that it would bring so many benefits - for the quality of services, the use of resources and the economy. This was enough to sell the skin before the bear was shot, says Cecilie Campbell.
She works as a network coordinator for welfare technology and digital home follow-up in Møre og Romsdal, a position funded by the municipal sector organization KS. Campbell also heads the Arena for Learning about Welfare Technology (ALV Møre og Romsdal), a partnership between municipalities and NTNU.
- The technology was immature and people didn't understand how much organizational change was needed. What's more, there were mostly only enthusiasts working on the topic. The positions were lacking, she says.
Moving slowly
Some municipalities still haven't hired people to work specifically with technology in health and care.
- Not allocating enough staff resources is one of the main reasons why the implementation of welfare technology is so slow, says Søgni Margrete Grøndal.Welfare technology is a solution that gives people in need of help greater opportunities to manage on their own, and for example live at home longer. The technology should also provide increased security and quality of life. It can be anything from medicine dispensers to digital supervision through sensors, GPS or cameras.
Grøndal is employed by Sykkylven municipality as a welfare technology consultant and is the project manager for the National Welfare Technology Program for Midtre Sunnmøre, which consists of five municipalities.
- The work is very complex and involves many different professional groups. If those involved don't have good information about the technology and the possibilities, it won't work, says Grøndal.
Three areas
Grøndal and Campbell work with three main focus areas: The first is safety and coping, which covers everything from digital safety alarms and fall sensors to notification and localization with GPS or medicine dispensers and digital supervision.The second area is welfare technology for children and young people with disabilities and people with disabilities - for example, a robot substitute in the classroom for children who are unable to attend school for long periods of time.
The third area is digital home follow-up, where municipalities collaborate with hospitals to follow up patients with specific diagnoses while they are at home.
- We still need more understanding of why technology is important. Nor are we good enough at realizing the benefits, says Grøndal.
To achieve this, it's important to understand that it's not the technology itself that saves the day, but rather the good organizational changes it facilitates. Grøndal calls for better plans to realize the benefits.
- If, for example, the use of digital supervision or medicine dispensers leads to time savings for the home care service, the head of department must have a plan for the time saved, otherwise it will disappear, says Grøndal.
Alternative ways of working
Etty Ragnhild Nilsen is a professor at the Department of Nursing and Health Sciences at the University of Southeast Norway.- It may sound easy to just install a sensor or buy a medicine dispenser, but it's about finding completely different ways of working, she says.
Nilsen believes this has been a mistake in the implementation process over the past 15 years.
- There has been too much focus on the technology itself, and not enough on the other organizational factors. It's not the technology that's the barrier here. Technological development is moving faster than we can keep up with, she says.
On the other hand, it's very much about change management. Could digital supervision lead to the municipality cutting one of its night shifts? Or could it give care center staff more quality time with the residents?
- Managers in health and care have far too much to do already, so they don't have time to figure this out, says Nilsen.
Transformation
Thor Steffensen is a senior advisor at the former Norwegian Directorate for E-health, now the Norwegian Directorate of Health. He has worked with the National Welfare Technology Program since its beginning and has been head of the program for two years.
- To get started, the municipalities need to invest, and it takes time for the benefits to materialize. Municipalities need to invest in both procurement and effort to find new ways of working, he says.Steffensen believes that many have underestimated the necessary change processes, and haven't quite realized that a new process map is needed for health and care.
- This isn't like buying a new Office package. If you start with procurement and forget about the change management required, then new ways of working will not be properly implemented and the potential for gains will not be exploited, he says.
He believes, for example, that digital monitoring, where different types of sensors detect if there is anything abnormal, can help to significantly reduce the number of visits to home care services.
- Then you might not have to drive out at night and go into the room of a sleeping elderly person to wake them up, just to see how things are going, says Steffensen.
In other words, management needs to understand the full scope of the service innovation that new technology makes possible, and what it takes to introduce the technology properly.
- Digital transformation must be incorporated into management training and businesses. It also needs to become clearer what government support can contribute - both legally, technically and in terms of funding models,” says Steffensen.
Coordinators
Gunn Hilde Rotvold is a research fellow at the Norwegian Center for E-health Research. She is researching the introduction of welfare technology, also known as safety and coping technology, by municipalities.- The development is happening step by step, but very, very slowly, she says.
Her work shows that municipalities are struggling to integrate the technology throughout their services, and that the initiatives are still very vulnerable because they have become dependent on enthusiasts pushing for it.
- I've looked at the coordinators in particular, says Rotvold.
Welfare technology coordinators are often the first position that municipalities allocate resources to in this field. Coordinators often work with welfare technology alongside other health service roles.
- They are often very close to the service. For example, there may be someone who is a 50/50 home nurse and coordinator. They might achieve something good where they work, but they are not well equipped to take on this responsibility for the entire municipal health and care service, says Rotvold.
She explains that the coordinators often meet resistance, and are thus left quite alone as a kind of salesperson for welfare technology in the municipal organization. Rotvold believes that the understanding of why the technology should be introduced must be better anchored than this.
- The belief that technology will help us and that it will be good for users is not an integral part of the development of health and care services today - in other words, professional development, says Rotvold.
She describes skepticism about what kind of effect the technology will have, and a lack of studies documenting the effects.
- I think managers need to take greater ownership of the changes that are coming. Many managers internally in the municipalities do not have this well enough under their skin, says Rotvold.
Own unit
Mike Görtz is project manager for establishing a separate unit for e-health and welfare technology in Bjørnafjorden municipality in Vestland. He has previously worked as a municipal manager for several other municipalities.- It's no use investing if we don't change attitudes, behavior and procedures. Welfare technology is not plug & play, he says.
Görtz emphasizes that anchoring must go upwards towards administration and political leadership, but also downwards in the system.
- Healthcare professionals need to have confidence in the technology and believe that it will benefit patients and users. I've seen that things can be well anchored upwards, but the confidence of healthcare workers isn't there, so you end up working as before, he says.
Like Steffensen, he points to the example of sleeping elderly people who need supervision at home.
- Imagine different people coming in every night, in your private home, while you are in a vulnerable state of sleep. Avoided costs and saved time are important, but we should also remember increased quality. It's not really a good service when you're woken up in the middle of the night just because someone wants to see if you're okay, he says.
Like Nilsen, he points out that unit managers and department heads in municipal health and care services have far too much to do.
- Resources are tight in the municipalities. When you introduce welfare technology, you need to free up resources to create a proper project plan and ensure that the expertise in change management and digital understanding is in place, says Görtz.
Reaping the benefits is one thing, but documenting them is another. Görtz calls for more follow-up research that can document the benefits achieved in the form of saved time, avoided costs and increased quality.
- This type of follow-up research is carried out far too little, he says.
It's all about the service
Else Kristin Tobiassen is an advisor in the Norwegian Association of Local and Regional Authorities (KS), Department of eHealth. Among other things, she follows up the municipalities' various health and welfare technology projects.- There's a lot of focus on ‘what’ and ‘why’, but the municipalities say they need to work much more on ‘how’, she says.
In other words: how to work and get help to work in new ways.
- Sometimes we're too focused on the technology and forget that it's the services that matter. No technology is suitable for everyone. The important question is what services the citizen needs, says Tobiassen.
She points to Lillestrøm municipality as a good example.
- They don't think about technology first, but focus on the services. It should be as natural to choose technology as anything else when allocating a service. Then user participation and the best interests of the user become more important than the technology itself, says Tobiassen.
She believes that terms such as 'welfare technology' are on their way out.
- Many municipalities only talk about technology now, and often resource-saving technology. It's important to clear up some of the terms that contribute to confusion in the field, says Tobiassen.
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Key principles for decision makers
As part of the PROTECT network project, Nordic researchers have developed advice for the introduction and use of technology in health and care. They include this set of principles:
- Embrace collective approach
Ensure multi- and transdisciplinary partnerships, user involvement and participatory processes, and bottom-up policy development. - Conduct orientation activities
Provide understanding, not just training, and facilitate processes with room for co-creation and critical attitudes. - Recognize user diversity
Remember that no two users are the same and that everyone has different needs. - Seek consensus
Clarify terms and create a common understanding of what health and welfare technology is and how it should be used.
Source: Proactive health and welfare technology for Nordic users and societies - A policy brief
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Advice at the implementation level
This is the PROTECT researchers' advice for health and welfare technology at the implementation level (see separate cases for advice at the community and user level):
- Execute change management
- Technology is changing services, processes, work environments and care itself. Change management is needed at all levels and stages.
- Smaller pilots and tests can show the way and build knowledge about short-term effects.
- Put in place larger intervention and impact studies. - Ensure good implementation
- It is very important that the technology is well anchored at different levels in the organizations.
- Know the prerequisites for good implementation - for example, time, money, knowledge and infrastructure. - Make sure the technology makes sense
– Increase the understanding of why technology is, can be or should be used - both by employers and healthcare professionals. - Ensure enough knowledge
- Provide insight, education, training and competence
- Knowledge makes it easier to ensure accessibility, suitability and utility for a diversity of users.
- Key questions are: What kind of technology should be used and when? What is accessible, essential and useful and for whom? What kind of education, training or competence building is needed? - Conduct impact and cost-benefit studies
- In order to gather the knowledge needed, it is important to conduct research using different methods on both effect and cost-benefit.